A Simple Goal Elicitation Tool Improves Shared Decision Making in Outpatient Orthopedic Surgery: A Randomized Controlled Trial.
A Simple Goal Elicitation Tool Improves Shared Decision Making in Outpatient Orthopedic Surgery: A Randomized Controlled Trial.
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DOI：
10.1177/0272989x20943520
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发表时间：
2020-08
期刊：
影响因子：
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通讯作者：
Kamal RN
中科院分区：
文献类型：
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作者：
Mertz K;Shah RF;Eppler SL;Yao J;Safran M;Palanca A;Hu SS;Gardner M;Amanatullah DF;Kamal RN
共同决策涉及教育患者，引出他们的目标，并合作决定治疗。目标诱导对医生来说是一个挑战，因为以前的研究表明，病人不会自己提出他们的目标。未能正确地引出病人的目标导致增加病人的误解和决策冲突。我们进行了一项随机对照试验，以测试一个简单的目标诱导工具在提高患者参与决策的有效性。我们对一个门诊手术中心的新患者进行了一项随机、单盲研究。在咨询之前，干预组接受了人口统计学调查问卷和目标诱导工作表。对照组仅接受人口统计学调查问卷。咨询后，两组被要求完成感知参与护理量表（PICS）调查。我们使用非参数Mann Whitney Wilcoxon检验比较了干预组和对照组的平均PICS评分。次要分析包括患者目标的定性内容分析。我们的最终队列包括96例患者（46例干预，50例对照）。这两个群体在人口构成方面相似。干预组的平均PICS评分显著高于对照组（9.04（SD 2.15）vs. 7.54（SD 2.27），p <0.01）。39%的患者的目标集中在接受诊断或治疗，而21%的患者希望接受有关其疾病或治疗方案的教育。一个单一的步骤目标启发工具是有效的，在提高病人的感知参与他们的护理。该工具可以在学术和非学术环境中有效地实施。
Shared decision making involves educating the patient, eliciting their goals, and collaborating on a decision for treatment. Goal elicitation is challenging for physicians as previous research has shown that patients do not bring up their goals on their own. Failure to properly elicit patient goals leads to increased patient misconceptions and decisional conflict. We performed a randomized controlled trial to test the efficacy of a simple goal elicitation tool in improving patient involvement in decision making. We conducted a randomized, single blind study of new patients presenting to a single, outpatient surgical center. Prior to their consultation, the intervention group received a demographics questionnaire and a goal elicitation worksheet. The control group received a demographics questionnaire only. After the consultation, both groups were asked to complete the Perceived Involvement in Care Scale (PICS) survey. We compared the mean PICS scores for the intervention and control groups using a nonparametric Mann Whitney Wilcoxon test. Secondary analysis included a a qualitative content analysis of the patient goals. Our final cohort consisted of 96 patients (46 intervention, 50 control). Both groups were similar in terms of demographic composition. The intervention group had a significantly higher mean PICS score compared to the control group (9.04 (SD 2.15) vs. 7.54 (SD 2.27), p < 0.01). 39% of patient goals were focused on receiving a diagnosis or treatment, while 21% of patients wanted to receive education regarding their illness or their treatment options. A single-step goal elicitation tool was effective in improving patient perceived involvement in their care. This tool can be efficiently implemented in both academic and non-academic settings.